Chapter 1
Drug treatments (such as penicillin), alongside increased control of infectious disease through vaccination and
improved sanitation, are partial explanations of increases in life expectancy seen globally.
Exposure to health risks and behavioural factors are thought to account for gender differences (including earlier
healthcare-seeking behaviour among females).
It is worth noticing that life expectancy is not the same as health life expectancy - the latter relates to whether
gains in life expectancy are lived in good health as opposed to in a state of poorer health, with some illness or
disability.
Mortality: death. The number of deaths in a given population and/or a given year ascribed to a given condition.
Circulatory diseases are worldwide the main cause of death. With the exception of lung cancer, cancer does not
appear in the top ten globally; however within more developed countries cancer is consistently placed in the top
five causes of death. In some European countries, cancers were the main causes of death.
The higher incidence of cancer deaths among men are attributed to lifestyle - behaviours such as smoking and
drinking plus poorer screening uptake - however, given the cardiovascular/circulatory diseases are in fact higher
in women, some risk behaviours in women may in fact be higher.
The upturn in cancer deaths seen over the last century is also, however, due to people living longer with other
illnesses they previously would have died from; thus they are reaching ages where cancer incidence is greater.
Incidence: the number of new cases of disease occurring during a defined time interval - not to be confused
with prevalence, which refers to the number of established cases of a disease in a population at any one time.
The extent to which history has seen these existing as separate, independent entities (dualistic thinking) with
either the body influencing the mind or the mind influencing the body, can be seen in part as the story of the
development of health psychology.
Dualism: the idea that the mind and body are separate entities (Descartes).
The ancient greek (Hippocrates) thought that when a person was healthy the four humours were in balance, and
when they were ill balanced due to external ‘pathogens’, illness occurred. The humours were attached to
seasonal variations and conditions. Where phlegm was attached to winter (cold-wet), blood to spring (wet-hot),
black bile to autumn (cold-dry), and yellow bile to summer (hot-dry).
Galen considered there to be a physical or pathological basis for all ill health (physical or mental) and believed
not only that the four bodily humours underpinned the four dominant temperaments identified by Hippocrates,
but also that these temperaments could contribute to the experience of specific illnesses. The mind itseld was not
thought to play a role in illness aetiology.
Aetiology: the cause of a disease.
During the early Middle Ages, health became increasingly tied to faith and spirituality.
During the Renaissance, individual thinking became increasingly dominant and the religious perspective became
only one of many.
Where the ancient Greeks had the body ‘in charge’, classical dualism placed the mind in charge - the
non-physical mind was thought to control the physical body and its reactions. The communication was thought
to be under the control of the pineal gland and the midbrain.
The dualist notion of the body as a machine (mechanistic viewpoint), understandable only in terms of its
molecular, biological parts, meant that illness was understood through the study of cellular and physiological
processes.
,Within the biomedical model of illness the ‘mind’ is considered part of the material stuff by virtue of it being a
function of the brain, and the study of mental processes is the mapped through physical, neural processes of the
brain (this monist materialism reduces the mind to objectifiable brian processes, and is supported by the huge
growth in neuropsychology and brain imaging research). Behaviourism is similarly monist, and at its extreme,
rejects the study of the non-visible mind and its thought processes in favour of observable stimuli and responses.
Humanism in contrast would argue that only through understanding the unique human subjective experience
will we gain understanding of individual behaviour.
Health: the absence of disease, and any symptom of illness it thought to have an underlying pathology that will
hopefully, but not inevitable, be cured through medical intervention.
The biomedical view has been described as reductionist: the basic idea that mind, matter and human behaviour
can all be reduced to, and explained at, the level of cells, neural activity or biochemical activity. It also tends to
ignore evidence that different people respond in different ways to the same underlying pathology because they
vary in, for example, personality, cognition, social support resources or cultural beliefs.
Evidence of individual variation in the response to impairment and disability challenges biomedical thinking
and opens the door for biopsychosocial thought.
Freud stimulated much work into unconscious conflict, personality and illness, linking the mind with the body
and ultimately leading to the development of the field of psychosomatic medicine.
Biopsychosocial model: a view that diseases and symptoms can be explained by a combination of physical,
social, cultural and psychological factors.
Disability no longer resides within the individual, but is a response to other factors including the physical, social
and cultural environment the person is trying to function within, and on their own personal characteristics,
behavioural and illness related beliefs and feelings.
People with diagnoses of quite serious illness made three main types of response whereby being health was:
1. Consisdered as a ‘general sense of wellbeing’
2. Identified with ‘the absence of symptoms of disease’
3. Seen in ‘the things that a person who is physically fit is able to do’
Bauman (researcher) argued that these three types of response reveal health to be related to:
- Feeling
- Symptom orientation
- Performance
→ Subjective health judgements were more tied to health behaviour in ‘healthier’ individuals. Health is
considered differently when it is no longer present. Ill people focus more on the ‘being’ healthy and ‘doing’
aspects.
Health behaviour: behaviour performed by an individual, regardless of their health status, as a means of
protecting, promoting or maintaining health.
Categories of health identified from a survey:
- Health as not ill: no symptoms, no doctor visits.
- Health as reserve: quick recovery from operation.
- Health as behaviour: usually applied to others rather than self; because they look after themselves,
exercise, etc.
- Health as physical fitness and vitality: in males this is more commonly tied to ‘feeling fit’, whereas
females had a concept of ‘feeling full of energy’ and rooted health more in the social world.
- Health as psychosocial wellbeing: defined in terms of a person’s mental state; being in harmony.
- Health as function: the ability to perform one’s duties or meet role expectations; being able to do what
you want when you want without being handicapped in any way by ill health or physical limitation.
,Psychosocial: an approach that seeks to merge a psychological (more micro- and individually oriented)
approach with a social approach (macro-, more community- and interaction-oriented) for example, to health.
People try to get the best out of their evaluations- a young person will tend to perceive their peers as generally
healthy, so if they are not healthy, they will be less likely to draw this comparison. In contrast, older people in
poorer health are more likely to compare themselves with same-aged peers, who may also have normatively
poorer health, thus their own health status seems less unusual.
Health is a relative state of being.
WHO (1947) definition of health: state of complete physical, mental and social well being and … not merely the
absence of disease or infirmity.
It is clear that health policy acknowledges the evidenced relationship between people’s behaviour, life-styles and
their health. What has often been less explicitly acknowledged and addressed are the socio-economic and
cultural influences on health, illness and health decisions.
Bircher (2005) defines health: a dynamic state of well-being characterized by a physical and mental potential,
which satisfies the demands of life commensurate with age, culture, and personal responsibility. This view
places the individuals centrally in the experience of health and illness whereas the WHO definition does not.
Cultures vary in their health belief systems, health attributions and health practices.
The collectivist (and holistic: eastern and african cultures) approach to staying healthy and avoiding illness
differs from our individualistic (western cultures) approach to health.
Collectivist: a cultural philosophy that emphasises the individual as part of a wider unit and places emphasis on
duties above rights, with actions motivated by interconnectedness, reciprocity and group membership, rather
than individual needs and wants.
This belief in a community of individuals working together for the good of all can however lead to problems if a
person is ill or disabled and considered unable to contribute, with consequent stigma and sometimes even the
experience of personal harm.
Individualistic: cultural philosophy that places responsibility at the feet of the individual and emphasises rights
above duties; this behaviour is often driven by individual needs and wants rather than by community needs or
wants.
Holistic: root word ‘wholeness’; holistic approaches are concerned with the whole being and its well-being,
rather than addressing the purely physical or observable.
Poor health has been confirmed as both a predictor and as an outcome of social exclusion based on data.
Social exclusion: a multidimensional process through which individuals become disengaged from mainstream
society, depriving people of the rights, resources and services available to the majority.
The developmental process is a function of the interaction between three factors:
- Learning: a relatively permanent change in knowledge, skill or ability as a result of experience.
- Experience: what we do, see, hear, feel, think.
, - Maturation: thought, behaviour or physical growth, attributed to a genetically determined sequence of
development and ageing rather than to experience.
Piaget proposed a staged developmental structure to which, he considered, all individuals follow in sequence:
1. Sensorimotor (birth - 2 years): an infant understands the world through sensations and movement, and
moves from reflexive to voluntary action, but lacks symbolic thought.
2. Preoperational (2 - 7 years): symbolic thought develops, enabling imagination and intellectual
development through the emergence of simple logical thinking, play language, although preoperational
chcildern are generally egocentric.
3. Concrete operational (7 - 11 years): logical thought develops; can perform mental operations and
manipulate objects to enable problem-solving; others’ perspectives can also be understood.
4. Formal operational (12 - adulthood): abstract thought and imagination develop as does deductive
reasoning, metacognition and introspection. Not everyone may attain this level.
Egocentric: self-centred, such as in the preoperational stage of children, when they see things only from their
own perspective.
Erik Erikson secribed eight major life stages: five related to childhood development - infancy, early childhood,
pre-school, school age, adolescence, and three related to adult development - young adulthood, middle
adulthood, maturity. Each stage varies across different dimensions:
- Cognitive and intellectual functioning;
- Language and communication skills;
- The understanding of illness;
- Healthcare and maintenance behaviour.
How children communicate their symptom experience to parents and healthcare staff, their ability to act on
health advice, and the level of personal responsibility for disease management taken is, according to studies,
determined by the level of cognitive development attained.
In one research responses of children revealed progression of understanding and attribution of causes of illness,
and descriptions of how illness is defined, caused and treated emerge.
Under-7s generally explained illness on a ‘magical’ level - explanations are bases on association:
- Phenomenonism: until around 4-years old, illness was a sign or sound that the child has at some time
associated with illness, but with little grasp of cause and effect.
- Contagion: from around age 4, illness was caused by a person or object that is close by, but not
necessarily touching the child; or it can be attributed to an activity that occurred before the illness.
Bibace and Walsh found explanations of illness among 8 to 11 year olds to be mor concrete and base on causal
sequence:
- Contamination: they understand that illness can have multiple symptoms, and they recognise that
germs, or even their own behaviour, can cause illness.
- Internalisation: illness is within the body, and the process by which symptoms occur is partially
understood. The cause of a cold may come from outside germs that are inhaled or swallowed and enter
the bloodstream. These children can differentiate between body organs and function and can
understand specific, simple information about their illness.
Bibace and Walsh describe illness concepts during early adolescence (11 - 13 years) at an abstract level:
- Physiological: children reach a stage of physiological understanding where most can define illness in
terms of specific bodily organs or functions, and begin to appreciate multiple physical causes.
- Psychophysiological: from age 14 and in adulthood, many people grasp the idea that mind and body
interact, and understand or accept the role of stress, worry, etc. in the exacerbation and even the cause
of illness. However, many people of all ages fail to achieve this level of understanding about illness and
continue to use more cognitively simplistic explanations.
Drug treatments (such as penicillin), alongside increased control of infectious disease through vaccination and
improved sanitation, are partial explanations of increases in life expectancy seen globally.
Exposure to health risks and behavioural factors are thought to account for gender differences (including earlier
healthcare-seeking behaviour among females).
It is worth noticing that life expectancy is not the same as health life expectancy - the latter relates to whether
gains in life expectancy are lived in good health as opposed to in a state of poorer health, with some illness or
disability.
Mortality: death. The number of deaths in a given population and/or a given year ascribed to a given condition.
Circulatory diseases are worldwide the main cause of death. With the exception of lung cancer, cancer does not
appear in the top ten globally; however within more developed countries cancer is consistently placed in the top
five causes of death. In some European countries, cancers were the main causes of death.
The higher incidence of cancer deaths among men are attributed to lifestyle - behaviours such as smoking and
drinking plus poorer screening uptake - however, given the cardiovascular/circulatory diseases are in fact higher
in women, some risk behaviours in women may in fact be higher.
The upturn in cancer deaths seen over the last century is also, however, due to people living longer with other
illnesses they previously would have died from; thus they are reaching ages where cancer incidence is greater.
Incidence: the number of new cases of disease occurring during a defined time interval - not to be confused
with prevalence, which refers to the number of established cases of a disease in a population at any one time.
The extent to which history has seen these existing as separate, independent entities (dualistic thinking) with
either the body influencing the mind or the mind influencing the body, can be seen in part as the story of the
development of health psychology.
Dualism: the idea that the mind and body are separate entities (Descartes).
The ancient greek (Hippocrates) thought that when a person was healthy the four humours were in balance, and
when they were ill balanced due to external ‘pathogens’, illness occurred. The humours were attached to
seasonal variations and conditions. Where phlegm was attached to winter (cold-wet), blood to spring (wet-hot),
black bile to autumn (cold-dry), and yellow bile to summer (hot-dry).
Galen considered there to be a physical or pathological basis for all ill health (physical or mental) and believed
not only that the four bodily humours underpinned the four dominant temperaments identified by Hippocrates,
but also that these temperaments could contribute to the experience of specific illnesses. The mind itseld was not
thought to play a role in illness aetiology.
Aetiology: the cause of a disease.
During the early Middle Ages, health became increasingly tied to faith and spirituality.
During the Renaissance, individual thinking became increasingly dominant and the religious perspective became
only one of many.
Where the ancient Greeks had the body ‘in charge’, classical dualism placed the mind in charge - the
non-physical mind was thought to control the physical body and its reactions. The communication was thought
to be under the control of the pineal gland and the midbrain.
The dualist notion of the body as a machine (mechanistic viewpoint), understandable only in terms of its
molecular, biological parts, meant that illness was understood through the study of cellular and physiological
processes.
,Within the biomedical model of illness the ‘mind’ is considered part of the material stuff by virtue of it being a
function of the brain, and the study of mental processes is the mapped through physical, neural processes of the
brain (this monist materialism reduces the mind to objectifiable brian processes, and is supported by the huge
growth in neuropsychology and brain imaging research). Behaviourism is similarly monist, and at its extreme,
rejects the study of the non-visible mind and its thought processes in favour of observable stimuli and responses.
Humanism in contrast would argue that only through understanding the unique human subjective experience
will we gain understanding of individual behaviour.
Health: the absence of disease, and any symptom of illness it thought to have an underlying pathology that will
hopefully, but not inevitable, be cured through medical intervention.
The biomedical view has been described as reductionist: the basic idea that mind, matter and human behaviour
can all be reduced to, and explained at, the level of cells, neural activity or biochemical activity. It also tends to
ignore evidence that different people respond in different ways to the same underlying pathology because they
vary in, for example, personality, cognition, social support resources or cultural beliefs.
Evidence of individual variation in the response to impairment and disability challenges biomedical thinking
and opens the door for biopsychosocial thought.
Freud stimulated much work into unconscious conflict, personality and illness, linking the mind with the body
and ultimately leading to the development of the field of psychosomatic medicine.
Biopsychosocial model: a view that diseases and symptoms can be explained by a combination of physical,
social, cultural and psychological factors.
Disability no longer resides within the individual, but is a response to other factors including the physical, social
and cultural environment the person is trying to function within, and on their own personal characteristics,
behavioural and illness related beliefs and feelings.
People with diagnoses of quite serious illness made three main types of response whereby being health was:
1. Consisdered as a ‘general sense of wellbeing’
2. Identified with ‘the absence of symptoms of disease’
3. Seen in ‘the things that a person who is physically fit is able to do’
Bauman (researcher) argued that these three types of response reveal health to be related to:
- Feeling
- Symptom orientation
- Performance
→ Subjective health judgements were more tied to health behaviour in ‘healthier’ individuals. Health is
considered differently when it is no longer present. Ill people focus more on the ‘being’ healthy and ‘doing’
aspects.
Health behaviour: behaviour performed by an individual, regardless of their health status, as a means of
protecting, promoting or maintaining health.
Categories of health identified from a survey:
- Health as not ill: no symptoms, no doctor visits.
- Health as reserve: quick recovery from operation.
- Health as behaviour: usually applied to others rather than self; because they look after themselves,
exercise, etc.
- Health as physical fitness and vitality: in males this is more commonly tied to ‘feeling fit’, whereas
females had a concept of ‘feeling full of energy’ and rooted health more in the social world.
- Health as psychosocial wellbeing: defined in terms of a person’s mental state; being in harmony.
- Health as function: the ability to perform one’s duties or meet role expectations; being able to do what
you want when you want without being handicapped in any way by ill health or physical limitation.
,Psychosocial: an approach that seeks to merge a psychological (more micro- and individually oriented)
approach with a social approach (macro-, more community- and interaction-oriented) for example, to health.
People try to get the best out of their evaluations- a young person will tend to perceive their peers as generally
healthy, so if they are not healthy, they will be less likely to draw this comparison. In contrast, older people in
poorer health are more likely to compare themselves with same-aged peers, who may also have normatively
poorer health, thus their own health status seems less unusual.
Health is a relative state of being.
WHO (1947) definition of health: state of complete physical, mental and social well being and … not merely the
absence of disease or infirmity.
It is clear that health policy acknowledges the evidenced relationship between people’s behaviour, life-styles and
their health. What has often been less explicitly acknowledged and addressed are the socio-economic and
cultural influences on health, illness and health decisions.
Bircher (2005) defines health: a dynamic state of well-being characterized by a physical and mental potential,
which satisfies the demands of life commensurate with age, culture, and personal responsibility. This view
places the individuals centrally in the experience of health and illness whereas the WHO definition does not.
Cultures vary in their health belief systems, health attributions and health practices.
The collectivist (and holistic: eastern and african cultures) approach to staying healthy and avoiding illness
differs from our individualistic (western cultures) approach to health.
Collectivist: a cultural philosophy that emphasises the individual as part of a wider unit and places emphasis on
duties above rights, with actions motivated by interconnectedness, reciprocity and group membership, rather
than individual needs and wants.
This belief in a community of individuals working together for the good of all can however lead to problems if a
person is ill or disabled and considered unable to contribute, with consequent stigma and sometimes even the
experience of personal harm.
Individualistic: cultural philosophy that places responsibility at the feet of the individual and emphasises rights
above duties; this behaviour is often driven by individual needs and wants rather than by community needs or
wants.
Holistic: root word ‘wholeness’; holistic approaches are concerned with the whole being and its well-being,
rather than addressing the purely physical or observable.
Poor health has been confirmed as both a predictor and as an outcome of social exclusion based on data.
Social exclusion: a multidimensional process through which individuals become disengaged from mainstream
society, depriving people of the rights, resources and services available to the majority.
The developmental process is a function of the interaction between three factors:
- Learning: a relatively permanent change in knowledge, skill or ability as a result of experience.
- Experience: what we do, see, hear, feel, think.
, - Maturation: thought, behaviour or physical growth, attributed to a genetically determined sequence of
development and ageing rather than to experience.
Piaget proposed a staged developmental structure to which, he considered, all individuals follow in sequence:
1. Sensorimotor (birth - 2 years): an infant understands the world through sensations and movement, and
moves from reflexive to voluntary action, but lacks symbolic thought.
2. Preoperational (2 - 7 years): symbolic thought develops, enabling imagination and intellectual
development through the emergence of simple logical thinking, play language, although preoperational
chcildern are generally egocentric.
3. Concrete operational (7 - 11 years): logical thought develops; can perform mental operations and
manipulate objects to enable problem-solving; others’ perspectives can also be understood.
4. Formal operational (12 - adulthood): abstract thought and imagination develop as does deductive
reasoning, metacognition and introspection. Not everyone may attain this level.
Egocentric: self-centred, such as in the preoperational stage of children, when they see things only from their
own perspective.
Erik Erikson secribed eight major life stages: five related to childhood development - infancy, early childhood,
pre-school, school age, adolescence, and three related to adult development - young adulthood, middle
adulthood, maturity. Each stage varies across different dimensions:
- Cognitive and intellectual functioning;
- Language and communication skills;
- The understanding of illness;
- Healthcare and maintenance behaviour.
How children communicate their symptom experience to parents and healthcare staff, their ability to act on
health advice, and the level of personal responsibility for disease management taken is, according to studies,
determined by the level of cognitive development attained.
In one research responses of children revealed progression of understanding and attribution of causes of illness,
and descriptions of how illness is defined, caused and treated emerge.
Under-7s generally explained illness on a ‘magical’ level - explanations are bases on association:
- Phenomenonism: until around 4-years old, illness was a sign or sound that the child has at some time
associated with illness, but with little grasp of cause and effect.
- Contagion: from around age 4, illness was caused by a person or object that is close by, but not
necessarily touching the child; or it can be attributed to an activity that occurred before the illness.
Bibace and Walsh found explanations of illness among 8 to 11 year olds to be mor concrete and base on causal
sequence:
- Contamination: they understand that illness can have multiple symptoms, and they recognise that
germs, or even their own behaviour, can cause illness.
- Internalisation: illness is within the body, and the process by which symptoms occur is partially
understood. The cause of a cold may come from outside germs that are inhaled or swallowed and enter
the bloodstream. These children can differentiate between body organs and function and can
understand specific, simple information about their illness.
Bibace and Walsh describe illness concepts during early adolescence (11 - 13 years) at an abstract level:
- Physiological: children reach a stage of physiological understanding where most can define illness in
terms of specific bodily organs or functions, and begin to appreciate multiple physical causes.
- Psychophysiological: from age 14 and in adulthood, many people grasp the idea that mind and body
interact, and understand or accept the role of stress, worry, etc. in the exacerbation and even the cause
of illness. However, many people of all ages fail to achieve this level of understanding about illness and
continue to use more cognitively simplistic explanations.
